• Actividad física en el trabajo y su asociación con síndrome metabólico: un estudio de base poblacional en Perú

      Bernabé Ortiz, Antonio; Arsentales Montalva, Valeria; Tenorio Guadalupe, María Del Rosario; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-15)
      Introduction: The priority role of physical activity, both in the prevention and in the management of the components of the metabolic syndrome, has been widely established in the last decade. Objectives: To evaluate the association between physical activity levels at work and the presence of metabolic syndrome among individuals aged ≥20 years in different geographical settings of Peru. Materials and methods: A secondary analysis of a population-based survey was conducted. Five population strata of Peru were included. The data were in accordance with the methodology of the National Institute of Statistics and Informatics. The diagnosis of metabolic syndrome was established according to internationally consensus criteria, based on the anthropometric, biochemical and clinical parameters that are involved in its diagnosis. The exposure of interest was physical activity at work, split into high, moderate and low levels. To evaluate the association of interest, the Poisson regression model was used and crude and adjusted models were created. Results: The data of 4029 individuals were analyzed, average age of 42.1 years (SD 15.3) and 2013 (50.0%) were women. A total of 1011 (25.1%; 95% CI: 23.8% - 26.5%) subjects presented metabolic syndrome, and this percentage varied according to the study region. Metabolic syndrome was more frequent in Lima (29.6%) and the rest of the Coast (30.8%), and less frequent in the rural Sierra (17.4%, p<0.001). The multivariate model showed evidence of association between physical activity at work and the presence of metabolic syndrome. When compared to those who had high physical activity levels at work, those who reported moderate levels of physical activity were 1.51 (95% CI: 1.25-1.81) more likely to have metabolic syndrome, whereas among those with low levels of physical activity levels at work the association was stronger (1.71, 95% CI: 1.42 - 2.07). Conclusions: Low levels of physical activity at work are strongly associated with the presence of metabolic syndrome. For this reason, measures to increase the performance of physical activity at work should be promoted to contribute to the reduction of the prevalence of MS in our population.
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    • Asociación entre el riesgo de adicción de sustancias psicoactivas y la adherencia a la terapia antiretroviral de gran actividad en personas que viven con VIH en un hospital de Lima, Perú en el periodo de 2015 – 2016

      Lucchetti Rodríguez, Aldo Javier; Fiestas Saldarriaga, Fabián Alejandro; Huertas Tirado, Sheila María; Zegarra Buitrón, Elizabeth (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-01)
      Introducción La adherencia al tratamiento es el factor más importante para lograr éxito en la terapia anti – retroviral. Sin embargo, aquella podría verse afectada por el consumo de sustancias psicoactivas. Objetivo Evaluar la asociación entre el riesgo de adicción a sustancias psicoactivas, medido por el “Alcohol, Smoking and Substance Involvement Screening Test” (ASSIST) y la adherencia a la terapia anti - retroviral de gran actividad (TARGA) medido por el “Simplified Medication Adherence Questionnaire” (SMAQ) en personas que viven con el virus de inmunodeficiencia humana (VIH). Métodos Se desarrolló un estudio transversal en el Hospital Nacional Edgardo Rebagliati Martins (HNERM). Se aplicó una ficha de datos, y las encuestas ASSIST y SMAQ. Resultados Se obtuvo un total de169 personas que viven con VIH. El sexo masculino predomino (79,3%), la mediana de edad y tiempo en TARGA fueron 43 años (IQR 35 - 50) y 63 meses (IQR 20 – 156), respectivamente. El consumo de alcohol de bajo riesgo fue más frecuente (84,6%), y se encontró un riesgo moderado a alto de tabaco (35,5%). La adherencia global al TARGA para nuestro estudio fue baja (23,1%). Los pacientes de mayor edad presentaron mayor adherencia (42,9%), con asociación significativa en el modelo regresión logística (edad ≥ 53 años) (p=0,004; OR 8,55; IC 95% 2,00 – 36,57). Conclusiones No se encontró asociación entre el riesgo de adicción a sustancias psicoactivas y adherencia al TARGA. Se encontró una baja adherencia al TARGA según el SMAQ. Además, la edad es un factor asociado positivamente a la adherencia al TARGA.
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    • Asociación entre la sintomatología climatérica y la adherencia al Tratamiento Antirretroviral de Gran Actividad en mujeres peruanas en edad mediana con infección por el virus de inmunodeficiencia humana

      Mezones Holguín, Edward; Cutimanco Pacheco, Victor Alejandro; Arriola Montenegro, Jose Jorge; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-05)
      Association between climacteric symptomatology and adherence to Highly Active Antiretroviral Therapy in middle-aged Peruvian women with human immunodeficiency virus infection Objective: To evaluate the association between Climacteric Symptomatology (CS) and adherence to highly active antiretroviral therapy (A-HAART) in middle age women (40 to 59 years old) with HIV infection. Methods: We carried out a cross-sectional study in Lima, Peru. The CS was categorized in: no symptomatology (NS), mild symptomatology (MiS), moderate symptomatology (MoS) and severe symptomatology (SS), using the score of the Menopause Rating Scale (MRS). According to the global score of the Antiretroviral Treatment Adherence Evaluation Questionnaire (CEAT-HIV), the patients were classified as: adherent and non-adherent to HAART. Also, age, sexual orientation, HAART scheme, time with HIV infection, menopausal stage, risk of depression and comorbidities were measured as control variables. We performed Poisson generalized linear models with non-parametric boostrap for calculating prevalence ratios at crude (PR) and adjusted by statistical and epidemiological criteria (aPR). Results: We included 313 in the analysis, 70.6% were non-adherent to HAART. Regarding CS, 19.9% had MiS, 32.6% had MoS and 15% had SS. The probability of non-adherent was superior in women with MiS, MoS and SS that those with NS; at crude model [PR:1.79 (CI95%: 1.39 a 2.29)], [PR:1.76 (CI95%: 1.38 a 2.23)], [PR:2.07 (CI95%: 1.64 a 2.61)], as well as adjusted by statistical criteria [aPR:1.80 (CI95%: 1.41 a 2.29)], [aPR:1.72 (CI 95%: 1.36 a 2.18)], [aPR: 2.06 (CI 95%: 1.64 a 2.60)] and adjusted by epidemiological [aPR:1.84 (CI95%: 1.45 a 2.34)], [aPR:1.83 (CI 95%: 1.44 a 2.32)], [aPR:2.17 (CI 95%: 1.73 a 2.73)]; respectively. Conclusions: Our results suggest that CS is associated with A-HAART independently of the clinical and demographic variables. The exploration of the CS on the women with HIV infection could be relevant in clinical practice arena.
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    • Calidad de vida en pacientes sobrevivientes de cáncer de cuello uterino en el Hospital Nacional Edgardo Rebagliati Martins, Lima. Perú

      Mezones Holguín, Edward; Jaimes Serkovic, Valentin Timoteo; Román Morillo, Yuani Miriam; Razo Huamaní, Ronald; Tomanguillo Vásquez, Miguel Alejandro (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-07-12)
      Objective: To compare quality of life (QoL) in cervical cancer survivors according to the stage at the time of diagnosis. Material and methods: An analytical cross-sectional study was carried out in adult female patients in gynecology oncology clinics of a national reference hospital of the Social Security in Health in Peru. The participants were divided into two groups: group A, consisting of women with a history of stage I and group B cancer, stages II and III. Quality of life was measured by the EORTC QLQ-C30 and QLQ-CX24 questionnaires. Other sociodemographic and clinical variables were also measured. We performed crude and adjusted linear regression models with non-parametric bootstrap with corrected and accelerated bias with a 95% confidence interval. Results: Group A and B were 59 and 61 women, respectively. In the models adjusted by age, education and presence of comorbidities, we found statistically significant differences in: global QoL (β=-8,84; p<0,001), physical functioning (β=-3,68; p=0,025), emotional (β=-4,34; p=0,046), cognitive (β=-7,18; p=0,001), social (β=-12,40; p<0,001), fatigue (β=6,02; p=0,022), constipation (β=14,82; p=0,002), diarrhea (β=8,02; p=0,007), financial difficulties (β=10,18; p<0,001), body image (β=-8,37; p<0,001), sexual enjoyment (β=8,72; p=0,025), sexual/vaginal functioning (β=-13,36; p<0,001), symptom experience (β=4,99; p=0,001) and peripheral neuropathy (β=12,95; p<0,001). Conclusions: The QoL of cervical cancer survivors has more deterioration in women whose stage at diagnosis was II and III. A comprehensive medical assessment and medical interventions are suggested.
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    • Características clínicas y demográficas de los pacientes con Cáncer de Mama Triple Negativo que recibieron quimioterapia neoadyuvante y tratamiento quirúrgico en el Instituto Nacional de Enfermedades Neoplásicas entre los años 2009-2014

      Morante Cruz, Zaida; Neciosup Delgado, Silvia Patricia; Soto Tarazona, Alonso Ricardo; Fortes Fortes, Pedro Pablo; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-06)
      Objective: Describe the sociodemographic and clinical characteristics of patients with triple-negative breast cancer, who underwent neoadjuvant chemotherapy and subsequent surgical intervention treated at the Instituto Nacional de Enfermedades Neoplásicas (INEN). Methods: A retrospective cohort study that included 175 patients with triple negative breast cancer, treated between 2009 and 2014, who underwent neoadjuvant chemotherapy and surgical intervention at the INEN. Through the development of a data collection form, we proceeded to obtain sociodemographic and clinical information. Pathological response was recorded from patient charts, based on the Miller-Payne classification, which assigns a histological grade based on the presence or absence of tumor cells. We used measures of central tendency and dispersion for the description of numerical variables, while absolute frequencies and percentages were used for categorical variables. Results: 175 patients were included, with an average age was 47.5 years (SD ±11.1). 47.4% of the patients had a positive family history of cancer. 45.7% of patients treated had a stage IIIB breast cancer. The most used chemotherapy regimen was paclitaxel, adriamycin and cyclophosphamide (52.6%). Of the 175 patients treated 22.9% had pathological complete response. The 5-year overall survival rate was 53.1%, with a median survival time of 2.87 years. Conclusions: The prevalence of breast cancer is high amongst the Latin-American population, especially young women. Triple negative breast cancer is exceedingly aggressive in comparison to other types of breast cancer. Despite advances in targeted therapy for breast cancer, the overall survival in triple negative breast cancer is inferior to other subtypes of breast cancer.
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    • Características clínicas, histopatológicas y factores asociados a adenomas de alto grado y adenocarcinoma colorrectal en un hospital oncológico de Lima, Perú.

      Carreazo Parsiaca, Nilton Yhuri; Parra del Riego Freundt-Thurne, Angela; Olivares Sparks, Andrea Sofía; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-30)
      Clinical and histopathological features associated with high grade dysplasia and colorectal adenocarcinoma. Aim: The aim of this study is to determine the associated factors to develop high-grade dysplasia and colorectal adenocarcinoma. Methods: This is a retrospective analytical cross-sectional study, which included all the polyps found in patient’s colonoscopies between 2014 and 2015 at Instituto Nacional de Enfermedades Neoplásicas (INEN). The primary outcome was the presence of high-grade dysplasia or colorectal adenocarcinoma. Multivariate analysis was done using the Generalized Estimating Equation (GEE) to analyze variables such as size, location, age, gender, number of polyps, personal history with the primary outcome. Results were reported in prevalence ratios (PR) and 95% confidence intervals. Results: From the 2439 patients who underwent a colonoscopy between 2014 and 2015, a total of 621 polyps from 416 patients (41.3% males and 58.7% females) were included in this study. The prevalence of high-grade dysplasia and colorectal adenocarcinoma found was 47,6%. The location of the polyps was 52,5% in the left-side and 47,5% in the right-side. Multivariate analysis showed that polyp size ≥1cm (RP=5,57, IC 95%: 4,16-7,47) and left-sided polyps (RP=1,20, IC 95%: 1,01-1,41) had higher probability to develop high-grade dysplasia or colorectal adenocarcinoma. Conclusions: An increase in polyp size and left-sided lesions are associated with high-grade dysplasia or colorectal cancer.
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    • Conocimientos nutricionales de la madre y estado nutricional infantil en el distrito de San Juan de Miraflores en la ciudad de Lima, Perú 2012

      Segura, Eddy R.; Herrera Sotero, Daniela; Morales Oliva, José Andrés (Universidad Peruana de Ciencias Aplicadas (UPC), 2014-01-29)
      Introducción: Los conocimientos nutricionales maternos pueden influir en el desarrollo de desnutrición crónica infantil. Al no contar con antecedentes en el Perú, este estudio busca encontrar dicha asociación. Métodos: Estudio de tipo transversal. Participaron madres de San Juan de Miraflores, acompañadas por sus hijos. Se evaluó el estado nutricional mediante tablas de la OMS; el nivel de conocimientos nutricionales mediante un cuestionario ad hoc (alpha de Cronbach = 0,76). Utilizamos la regresión logística para medir asociación de conocimientos, y otras variables, con desnutrición crónica infantil. Resultados: Encuestamos 150 madres, entre 19 y 56 años, con una mediana de 30 años. 69,3% cursó estudios secundarios, 67,1% era conviviente y 75,5% eran desempleadas. De 150 niños, la prevalencia de desnutrición crónica fue de 8,7%. Encontramos que los conocimientos nutricionales están asociados inversamente con el estado nutricional del niño (OR 0,28; p<0,05). También encontramos asociación entre el número de hijos y el estado nutricional (OR 2,06). El análisis de regresión logística múltiple demostró que los conocimientos mantenían su asociación pese a considerar la variable pobreza. Interpretación: La prevalencia de desnutrición crónica fue similar a resultados en Lima hallados anteriormente (ENDES 2011). Los resultados demuestran que los conocimientos nutricionales son un factor protector contra la desnutrición crónica en la población estudiada. Es posible que los conocimientos influyan en las actitudes y practicas nutricionales, llevando a un apropiado estado nutricional. Se encontró asociación entre desnutrición crónica y un mayor número de hijos, podría deberse a la decisión de comprar alimentos de menor calidad, o servir raciones más pequeñas. Futuros estudios podrán servirse de estos resultados como base.
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    • Factores asociados a la sobrevida global y sobrevida libre de enfermedad en pacientes con cáncer de mama triple negativo con quimioterapia neoadyuvante y tratamiento quirúrgico en el Instituto Nacional de Enfermedades Neoplásicas entre los años 2009-2014

      Morante Cruz, Zaida; Neciosup Delgado, Silvia Patricia; Soto Tarazona, Alonso Ricardo; Ruiz Huaranga, Edita Guadalupe; Barrantes Carmen, Adriana Lucero; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-06)
      Objective: The aim of this study is to identify associated factors with overall survival and disease-free survival in the Peruvian population attended at the Instituto Nacional de Enfermedades Neoplásicas (INEN) with triple-negative breast cancer that received neoadjuvant chemotherapy, and subsequent surgical treatment. Methods: A retrospective cohort study that included 175 patients with triple negative breast cancer with neoadjuvant chemotherapy and surgical treatment attended in the INEN between 2009 and 2014. A data collection form was drawn up to obtain sociodemographic and clinical information. For the measurement of the variable Pathological Response, defined by degrees that determine the absence, partial or total presence of neoplastic cells, the Miller-Payne classification was used, consigned in the patient's surgery report. Kaplan-Meier curves were constructed for the description of overall survival and disease-free survival. A hazard ratio (HR) was estimated in a bivariate and multivariate manner through the Cox Regression Model. Results: The factors that were associated with a lower overall survival were tumor size (HR= 1.09; 95% IC, 1.03 - 1.14; p<0.01) and lymph node involvement (HR=3.63; 95% IC, 1.98 - 6.67; p<0.00). A greater overall survival was associated with a complete pathological response (HR=0.36; 95% IC, 0.14 - 0.90; p=0.03). A total of 22.8% of patients presented complete pathological response, which corresponds to the absence of cancer cells through histological studies after neoadjuvant treatment, which was associated with a smaller tumor size (p <0.01) and conservative surgical intervention (p <0.01). No factors significantly associated with disease-free survival were found. Age was associated with disease-free survival in the bivariate analysis; however, in the multivariate analysis no statistically significant associated factors were found. Conclusions: The overall survival of patients with triple negative breast cancer in this population is negatively affected by a larger tumor size and lymph node involvement. The complete pathological response is associated with greater overall survival. No factors were found to be significantly associated with disease-free survival.
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    • Factores asociados a retención en el cuidado de personas viviendo con VIH/SIDA en el programa de un hospital de Lima, Perú

      Mendo Urbina, Fernando Cruz; Tejada Caminiti, Romina Arely; Parra Baltazar, Isabel Mónica; Quispe Iporra, Sara Grecia Esperanza; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-01)
      Introduction: The retention in the care is considered a crucial step to maximize the results in people who is living with HIV/AIDS (PLWHA), however, there is still limited information about its associated factors. Objectives: To identify the factors associated with retention in the care of PLWHA in the HIV/AIDS program of the Edgardo Rebagliati Martins National Hospital between 2010 and 2014. Materials and methods: A retrospective cohort study was conducted in a Social Security Hospital in Peru, where 624 participants were included through a census. Both clinical records and PLWHA program records were reviewed. In the multivariate analysis a generalized linear model of the binomial family and link log was used, since there was no convergence the Poisson family and link log with robust variance were used. Results: The incidence of retention was 52.6%, in addition, association with age was found, being significant in the adjusted model (RRa = 1.01, 95% CI 1.00 - 1.02) and with the distance to the establishment <5km (RRa = 1.18, 95% CI 1.00-1.38). Conclusions: In a hospital level IV (category III-1) of Lima, Peru, an incidence of retention in the care of 52.6% was registered, being below the figures recommended by the WHO (90%). Age older than 35 years and living at a distance <5km from your health facility, were the only factors associated with retention in care.
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    • Factores asociados a sobrevida en una cohorte de pacientes con VIH que iniciaron terapia antirretroviral (Targa) en el Hospital Nacional Arzobispo Loayza en Lima

      Suarez Ognio, Luis Antonio Nicolás; Lucchetti Rodriguez, Aldo Javier; Espinoza Morales, Diego Raúl (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-02-01)
      Objetivos: Determinar factores asociados a la sobrevida a 3 años de pacientes con infección por VIH que iniciaron terapia antirretroviral (TARGA) en el Hospital Nacional “Arzobispo Loayza” (HNAL) en Lima, Perú, durante los años 2004-2012. Materiales y métodos: Estudio retrospectivo de una cohorte de 2171 pacientes con diagnóstico de VIH que iniciaron tratamiento en el HNAL. Para evaluar los factores asociados a la sobrevida se compararon las características clínicas de los pacientes según el sexo, edad, la presencia de condición de SIDA al inicio y el esquema de terapia antirretroviral inicial. Realizamos un análisis multivariado de regresión de Cox para evaluar factores sociodemográficos, epidemiológicos y clínicos, obteniéndose los Hazard ratio (HR) y su IC 95%. Resultados: De 2171 pacientes, la población mayoritariamente fue masculina, soltera y con secundaria completa. En el grupo de sobrevivientes la mediana de CD4+ al inicio del TARGA fue de 132 células/ml y de 67 células/mL en el grupo no sobreviviente. A los tres años, 87% de los pacientes en TARGA sobrevivían (13% de Mortalidad). Se encontró como factores asociados a la sobrevida: El uso de Zidovudina/ Lamivudina/Efavirenz en comparación con otros esquemas de TARGA utilizados (HR: 0,51; IC95%:0,39-0,66), iniciar TARGA con más de 350 células/mL de CD4+ (HR: 0,29; IC95%: 0,12-0,71), tener algún grado de educación (HR: 0,48; IC95%: 0,26- 0,92) y ser casado (HR: 0,45; IC95%: 0,27-0,76). Conclusiones: La condición de ser casado, tener menos de 36 años, tener algún grado educativo e iniciar terapia con recuentos de CD4+ mayores a 350 células/mL aumenta la sobrevida durante los primeros 3 años.interventions to avoid this phenomenon can take place.
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    • Factores de riesgo asociados a la sobrevida renal en pacientes con nefritis lúpica clase III y IV en Lima

      Canelo Aybar, Carlos Gilberto; Valdivia Vega, Renzo Pavel; Choque Chávez, Fernando Diego; Huamaní Fuente, Francisco Javier (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-02-01)
      INTRODUCCIÓN: Se ha reportado que la nefritis lúpica (NL) en pacientes latinos tiene una mayor incidencia y un peor pronóstico que en pacientes de origen caucásico. Sin embargo, existe poca información en lo que respecta a poblaciones de alto mestizaje. El objetivo principal de este estudio fue determinar la sobrevida renal y los factores de riesgo para el desarrollo de enfermedad renal crónica estadio 5D (ERC-5D) en una población de pacientes mestizos con diagnóstico de nefritis lúpica clase III (NLIII) y clase IV (NLIV) en un hospital de Perú. MATERIALES Y MÉTODOS: Se evaluó una cohorte retrospectiva de pacientes con diagnóstico de lupus eritematoso sistémico (LES) y diagnóstico histopatológico de NLIII y NLIV de acuerdo a la clasificación de la Organización Mundial de la Salud (OMS) entre enero del 2000 y julio del 2014. Se recolectaron datos demográficos, clínicos, laboratoriales e histopatológicos, así como el índice de actividad e índice de cronicidad de las biopsias. Además, se estimó el índice de Actividad de Enfermedad de Lupus Eritematoso Sistémico (Systemic Lupus Erythematosus Disease Activity Index, SLEDAI). Se realizó un análisis de sobrevida para determinar la sobrevida renal, definida como el tiempo transcurrido desde el diagnóstico histopatológico de NLIII o NLIV hasta la aparición de ERC-5D, en los pacientes estudiados y se hallaron los factores de riesgo para desarrollar ERC-5D en la cohorte con razones de hazard mediante regresión de Cox. RESULTADOS: Se incluyeron 140 pacientes. A los 5 años de seguimiento, la sobrevida renal de la población estudiada fue de 72,51%. No se encontraron diferencias entre el tipo de nefropatía lúpica. En al análisis multivariado, se encontró que un mayor índice de actividad (HR 1,10; IC 95%: 1,01-1,19; p=0,027) y un valor aumentado de creatinina al diagnóstico (HR 1,23; IC 95%: 1,07-1,41; p=0,004) son predictores de desarrollo de ERC-5D. CONCLUSIONES: En una población, en su mayoría mestiza, la sobrevida renal fue menor a la reportada en poblaciones caucásicas y no guardó relación con el tipo de nefropatía lúpica. Además, un mayor índice de actividad y una función renal deteriorada al momento del diagnóstico representan factores de riesgo independientes para el desarrollo de ERC-5D.
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    • Factores de Riesgo asociados a Mortalidad Intrahospitalaria en pacientes con Injuria Renal Aguda en Hemodiálisis en Lima, Perú

      Carreazo Parsiaca, Nilton Yhuri; Valdivia Vega, Renzo Pavel; Cerna, Renato; Figueroa Tarrillo, Jorge Arturo (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-15)
      Introduction: The worldwide incidence of acute kidney injury (AKI) is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis (HD) patients. Objectives: To identify risk factors associated to hospital mortality of AKI in HD patients. Methods: This is a retrospective cohort of patients with AKI in HD patients on HNERM gathered between January 2013 and December 2015. The sample size was 154 patients. ICD-10 codes were used to identify medical records of patients with AKI (N.17) and HD (Z.49). The independent variable was oliguria and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. Results: Medical records of 212 patients were analyzed, from which 44 were excluded and 73 were not found, despite they belonged to living patients. Out of 168 medical records, 129 belonged to living patients and 39 to deceased ones. The principal etiologies of AKI in HD were sepsis (39,2%) and severe dehydration (10,8%). In the adjusted multivariate, the risk factors associated to hospital mortality were lactate RR 1.09 (IC 95% 1.04-1.15), potassium RR 0.93 (IC 95% 0.87-0.99), and mean arterial pressure RR 0.97 (IC 95% 0.96-0.98). Conclusions: Lactate is an objective parameter que can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.
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    • Factores de riesgo de la rosácea en un hospital de Lima, Perú

      Piscoya Rivera, José Alejandro; Umeres Álvaro, Juan; Chávez Montesinos, Diana Jeanette; Salazar Roggero, Yolanda (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-02-21)
      Introducción: La rosácea es una enfermedad inflamatoria crónica facial con fisiopatología desconocida a la que se le atribuyen múltiples factores asociados existiendo estudios con conclusiones diversas donde se evalúan variables como edad, género, fototipo, infecciones por Helicobacter pylori, historia familiar, antihipertensivos. Objetivo: Se determinó los diferentes factores de riesgo para el desarrollo de la rosácea. Materiales y Métodos: Estudio de casos y controles realizado en el Hospital EsSalud Angamos y el Hospital Nacional Edgardo Rebagliati Martins, hospitales de la seguridad social en Lima, Perú. Se coordinó con el dermatólogo a cargo del primer nosocomio para el diagnóstico, grado de severidad y fototipo según la clasificación de Fitzpatrick para los casos. Se les invitó a participar mediante el consentimiento informado. Se explicó el llenado de las encuestas y se mostró fotos para evaluar historia familiar. Los controles, al ser trabajadores de los nosocomios en mención, fueron captados en sus áreas laborales, solicitando el permiso para realizar las encuestas. Resultados: 148 casos y 592 controles. El sexo predominante tanto en casos como en controles fue femenino. La edad promedio de casos fue 50.7 años y de controles fue 42.1 años. El antecedente familiar fue significativamente mayor en los casos. Se encontró diferencia estadística significativa con fototipo IV (p<0.001), enfermedad crónica (hipertensión arterial (p<0.001) y diabetes mellitus (p=0.021)) y antihipertensivos bloqueadores de calcio (p<0.001). En el análisis multivariado, los factores de riesgo significativos fueron antecedente familiar, fototipo IV, antihipertensivos bloqueadores de calcio, tabaquismo y consumo de café. Conclusiones: El antecedente familiar, fototipo IV, antihipertensivos bloqueadores de calcio, tabaco y consumo de café son factores de riesgo para la rosácea.
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    • Frecuencia de nefropatía diabética y factores asociados en pacientes con diabetes mellitus tipo 2

      Tejada Caminiti, Romina Arely; Tara Britto, Susana Luisa; Carranza Neira, Fernando Ezequiel; Paredes Yauri, Stephania Raquel (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-05-16)
      Objectives: To determine the frequency and factors associated with diabetic nephropathy (DN) in endocrinologic outpatients with type 2 diabetes mellitus (T2DM) treated at the Edgardo Rebagliati Martins National Hospital between 2013-2014. Methods: We performed an analytical cross-sectional study. We reviewed clinical records to collect sociodemographic, clinical, and laboratorial variables. We obtained absolute and relative frequencies for qualitative variables and mean and standard deviation for quantitative variables. The bivariate analysis consisted in calculating crude (PR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (CI 95%), as well as chi-square and student’s t tests or U Mann Whitney test. We considered a significance level of 0.05. In the multivariate analysis, we used a generalized lineal model in which we used an epidemiological model with the variables related to DN and HbA1c. We use the program Stata v12.0. Results: We included 471 patients, mostly women (55.8%), with a mean age of 65 ± 11.4 years. Sixty-three percent were overweight or obese, 63.3% had arterial hypertension, 67.9% had an HbA1c greater or equal to 7%, and 58.4% had a complication due to DM2 without including DN. In addition, 81.3% of patients received oral antidiabetics therapy, and 48.6% used insulin. The prevalence of DN was 70.5%. The mean time between the diagnosis of T2DM and the diagnosis of DN was 14.2±10.1 years. The majority of patients (24.6%) had stage 1 chronic kidney disease. We found an association between DN and HbA1c equal to or higher than 7% (aPR: 1.19; CI 95%: 1.02-1.38: p: 0.024) and when they had more than 10 years of disease (aPR: 1.19; CI 95%: 1.03-1.38, p: 0.019). Conclusions: There is a high prevalence of DN, which is associated with poor glycemic control and longer disease duration. We must improve the control of patients with T2DM to prevent this complication from appearing.
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    • Frecuencia y factores asociados a viremia intermitente en personas viviendo con VIH/SIDA en el programa de un hospital de Lima, Perú

      Benites Zapata, Vicente A.; Pinto Dongo, Claudia Estefany (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-03-31)
      Objectives: To identify the factors associated with intermittent viremia in PLWHA who entered the HIV / AIDS program of the Edgardo Rebagliati Martins National Hospital between 2010 and 2014. Materials and methods: A secondary analysis of a database of PLWHA assisted the National Hospital Edgardo Rebagliati Martins; calculated considering that the base has 520 participants in TARGA, a frequency of intermittent viremia in patients on treatment with a protease inhibitor base of 48%. In this study it was not necessary to use an instrument, since it is based on a secondary basis. Results: When performing the statistical analysis of the variables, no association was found. The participants who had co-infection with tuberculosis were 46, representing 8.8%; and received prophylaxis with CMX 226 (43.5%) participants. The participants who presented an intermittent viremia were 37, representing an incidence of 7.12%. Conclusions: No factor associated with the variable intermittent viremia was found. The identification of associated factors would have been important to reduce the transmission of HIV and the development of resistance to TARGA.
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    • Índice de masa corporal asociado al daño en pacientes con Lupus Eritematoso Sistémico del Hospital Nivel IV Guillermo Almenara Irigoyen durante los años 2012- 2015

      Ugarte-Gil, Cesar; Ugarte-Gil, Manuel; Bernuy Pérez, Sandra Lizzet; Rivera Napancca, María Cristina; Salazar Lizárraga, Carmen Lourdes (Universidad Peruana de Ciencias Aplicadas (UPC), 01/03/2017)
      Introduction: To determine the association between body mass index (BMI) and damage in patients with systemic lupus erythematosus (SLE). Methods: This is a Cross-sectional analytical study. The main variables were body mass index (BMI) <25 kg/m2 (normal) and ≥25 kg/m2 (overweight and obesity) and damage measured by SLICC-ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) damage index. Other variables were sociodemographic and laboratory features, drug use and subtotal percentage of fat, leg fat, trunk fat and trunk/leg fat ratio. Results: There were studied, 309 patients. Women were 287 (92, 88%) and the average age was 42 ± 12, 98 years. The number of patients with BMI ≥ 25 kg/m2 was 194 (62, 78%). The prevalence of damage was 149 (48, 22%) patients. In the univariate analysis, the variables associated were advanced age, increased year of education, increased disease time, hypertriglyceridemia, hypercholesterolemia, low levels of HDL (<40mg/dl), higher creatinine levels, increased prednisone use, diagnosis of hypertension, actual use of immunosuppressive drugs and higher trunk/leg fat ratio. In the multivariate analysis, the associated variables were advanced age (PR:1,02; CI95%1,01-1,03), actual use of immunosuppressive drugs (PR:1,49; CI95% 1,02-2,19) and greater proportion of fat ratio trunk/leg (PR:1,24; CI95%:1,11-1,39). There was no association between BMI and damage. Conclusions: In the present study, no association between BMI (overweight/obesity) and damage was found. However, we obtained the association with the use of immunosuppressive drugs, higher trunk/leg fat ratio and older age.
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    • Mortalidad en pacientes con hemorragia digestiva alta variceal y no variceal: Estudio de cohorte retrospectivo en una unidad especializada de un hospital de la seguridad social en Lima, Perú, 2012-2013

      Segura Paucar, Eddy Roberto; Patiño Valderrama, Lía Aliosha; Tello Velásquez, Ana Claudia; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-30)
      Background and aim: In Peru, mortality due to Upper Gastrointestinal Bleeding (UGB) is still high. Our aim was to determine the risk factors for mortality after 30 days of UBG episode and its prediction using the Rockall score, according to type of UGB (variceal and non-variceal). Methods: A retrospective cohort study was performed from pre-existing data from 339 patients with clinical and endoscopic diagnosis of UGB admitted to the UHD from HNERM between June 2012 and December 2013. Clinical features and endoscopic findings were evaluated as risk factors associated with mortality using: chi square tests and Poisson regression analysis. We plot the ROC curve and calculate the area under the curve to analyze the Rockall scale as a mortality predictor. Results: A total of 339 patients were divided in two groups: variceal UGB (33%) and nonvariceal UGB (67%%). Mortality was greater in the first group (10.8% vs 7.9%), although without statistically significant difference. The factors associated with mortality in the non-variceal HDA were: heart rate, blood pressure, hematocrit, erosive esophagitis and treatment with argon plasma and clips. While in the HDA variceal were: heart rate, urea and treatment with variceal sclerotherapy. The ROC curve for non-variceal HDA mortality showed an area under the curve of 0.64 (95% CI 0.49-0.79), similar to the group with variceal HDA 0.43 (95% CI 0.27-0.59). Conclusions: In both UGB groups, different factors associated with mortality were found. In addition, the full Rockall scale does not predict mortality in either of the two subgroups with UGIB
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    • Prevalencia de mortalidad intrahospitalaria en pacientes con injuria renal Aguda en hemodiálisis en Lima, Perú

      Carreazo Parsiaca, Nilton Yhuri; Valdivia Vega, Renzo Pavel; Linares Linares, Mariela Alejandra (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-15)
      Introduction: The worldwide incidence of acute kidney injury is 18% and the overall mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. Objectives: To identify the hospital mortality prevalence of acute kidney injury in hemodialysis patients. Methods: This is a cross-sectional study of patients with acute kidney injury in hemodialysis of Hospital Edgardo Rebagliati Martins gathered between January 2013 and December 2016. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). Results: There were 285 medical records. 73 of them weren’t available. 212 medical records were analyzed and 44 were excluded. 168 medical records were taken into consideration for the analysis and 59 of the alive patients whose medical records were unavailable were added only for the prevalence calculation. The overall hospital mortality prevalence found was 17.2%. The principal etiologies of acute kidney injury that required hemodialysis were sepsis (39.2%) and severe dehydration (10.8%). Conclusions: The mortality prevalence was 17.2% in patients with acute kidney injury that required hemodialysis.
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